From: Dr David Cochrane, Director
Subject: PFI

The NHS has over planned acute hospital capacity for over 30 years now.   Most of the PFI acute schemes were based on a set of capacity modelling assumptions set by the DH in 2000 (the National Beds Inquiry) and were never planned, paying only lip service to whole-systems care.

However, given that closure or even downsizing of these gleaming new hospitals would be politically as well as financially challenging, the local commissioners and Trusts do have an option for internal re-design as single site integrated delivery systems.  The key here is the staffing and financial models which need to show a significant differential between acute care and other levels of care – in turn reflecting the differential in intensity of the service. (In the US it’s a factor of 3:1)

This can be achieved either by unbundling the tariffs or more radically and simply by capitating the provider, say for unscheduled care, so there is an incentive for the provider to re-design and release resources from within a more clinically appropriate pathway of care.